title: Embolization of patent foramen ovale closure devices: incidence, role of imaging in identification, potential causes, and management.
abstract: Transcatheter patent foramen ovale (PFO) closure is an alternative to antiplatelet or anticoagulative therapy in patients with cryptogenic stroke, and it is associated with a small incidence of periprocedural sequelae. Because embolization of PFO closure devices is a very rare procedural complication, data on its frequency, causes, and management are sparse. We sought to review the medical literature and the cases of PFO closure-device embolization at our institution with the aim of identifying likely problems and reporting potential solutions. Out of 310 adult patients who underwent transcatheter PFO closure from June 2002 through April 2011, there were 2 cases (0.6%) of PFO closure-device embolization. In both patients, hypermobile septum primum and thick septum secundum were present. In one patient, failure to use a sizing balloon might have resulted in an underestimation of the PFO's size. In both patients, device embolization was identified in a timely fashion, the embolized device was safely retrieved, and the PFO was percutaneously closed with success. The incidence of PFO closure-device embolization is very low. The cases described here underscore the importance of imaging in the identification of morphologic predispositions to closure-device malpositioning, in the recognition of impending embolization, and in the timely management of embolization.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195.
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Goel
authors.forename: Olcay
authors.initials: O
authors.lastname: Aksoy
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D054092:Foramen Ovale, Patent / Q000175:diagnosis / Q000628:therapy*; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012307:Risk Factors; D055989:Septal Occluder Device / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Contrast media/diagnostic use; device removal/methods; echocardiography, transesophageal; fluoroscopy; foramen ovale, patent/radiography/therapy/ultrasonography; foreign body migration; ischemic attack, transient/prevention & control; prosthesis implantation/adverse effects; septal occluder device/adverse effects; stroke/prevention & control